Collecting Branch : EPS1 Servicing Branch : 610

E-mail : bo_eps1@licindia.com LIC of India,Bangalore DAB

Phone : +91-022-1251 Direct Agents Branch (City Br VII)
Jeevan Prakash Annexe 1st Floor.
Transaction No. : PR0274510100011011 J C Road Bangalore
Bangalore
Date ( Time ): 02/12/2010 ( 10:59:56 ) Karnataka 560002

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 9690.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sri Kundan Kumar

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Branch

Name Term Mode Due Fr Late Fee Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
616112189 149 9,690.00 1 9,690.00 610
Kundan Kumar 74 YLY 12/10 0.00 12/11
01268610 07/12/2009 1,00,000.00 12/10 9,690.00
Page Total (Rs) 9,690.00 9,690.00
0.00
9,690.00
Grand Total (Rs) 9,690.00 9,690.00
0.00
9,690.00

RUPEES NINE THOUSAND SIX HUNDRED NINETY ONLY

Sri Kundan Kumar A.Mu.Sh.2010/1304/CR 324/M 1 Dated 23/06/2010

No 46 I Floor Gattigere Layout
Beml Layout 3rd Stage
Rajarajeshwari Nagar Bangalore
560098

This receipt is electronically generated and is digitally signed.

Signature Not Verified

Digitally signed by REKHA VARSHNEY
Date: December 2, 2010 10:59:57 AM IST
Reason: Premium Receipt
Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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